Phonation Resistance Training Exercises and Inspiratory Muscle Strength Training Improve Voice in Older Adults With...

This study examined the effects of implementing Phonation Resistance Training Exercises (PhoRTE) and Inspiratory Muscle Strength Training (IMST) sequentially to improve vocal function in older adults with presbyphonia.

A comparative single-subject experimental study was replicated in six older adults with presbyphonia. Participants were alternately assigned to an intervention order (PhoRTE-IMST or IMST-PhoRTE). Primary outcomes taken throughout the entire treatment were the Acoustic Voice Quality Index (AVQI), Acoustic Breathiness Index (ABI), and vocal effort. Secondary outcomes taken before and after each treatment phase were the Aging Voice Index (AVI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

All patients demonstrated improvement across all primary outcomes characterized by a decelerating trend. Participants assigned to the PhoRTE-IMST order demonstrated significant improvements in AVQI and ABI after PhoRTE initiation, which remained stable during the IMST phase. A steady positive trend was observed in vocal effort throughout the entire treatment. Participants assigned to the IMST-PhoRTE order demonstrated significant reductions in vocal effort after the initiation of IMST, and improvements in all primary outcome measures during the PhoRTE phase. Effects were maintained for all primary outcome measures at the 4-week follow-up in five out of the six participants, regardless of intervention order. Regarding auditory-perceptual outcomes, overall severity of voice quality improved after the entire treatment phase in all participants. Improvements in loudness were more pronounced following PhoRTE initiation, whereas reductions in strain and roughness were greater when treatment began with IMST. Less systematic improvement in voice-related quality of life was observed after the treatments.

This study suggests that combining both approaches yields improvements in voice quality and vocal effort. PhoRTE can improve acoustic indices of voice quality, particularly breathiness, as well as perceptual loudness, while IMST can play a role in reducing vocal effort and improving perceptual strain and roughness.